Strategic Framework for Alcohol Harm
Reduction in Lancashire
2014 to 2015
Contents
Page/s
Working in Partnership to Address Alcohol Harm Reduction
3
Strategy Summary
6
Action Plan Summary
7
Section 1
Purpose of the strategic framework
8
Section 2
Alcohol Harm Reduction – National and Regional Context
8
Section 3
Why alcohol harm reduction is important in Lancashire
Section 4
Addressing Alcohol related harm in Lancashire
Section 5
Action Plan
10
13
15
Appendices
Appendix 1
Minimum Unit Price and Alcohol Factsheet
13
2
Working in Partnership to Address Alcohol Harm
Reduction
Addressing alcohol related harm is a complex issue involving a range of partners
and partnership working is crucial to success in delivering change and many
different organisations have an important role to play. For some, such as the
NHS, the Police, Licensing and Councils representing their local communities,
tackling alcohol-related harm is part of their core business; for others, there is an
important role to play in designated areas of their own work. This approach has
the potential to deliver added value and ultimately to reduce alcohol related harm
and health inequalities across the County.
The Lancashire Alcohol Network (LAN) was established in September 2009
with the aim of providing strategic leadership to reduce alcohol related harm in
Lancashire. This partnership continued under a different guise since the NHS
changes which became effective in April 2013. At that time Public Health moved
from the NHS (PCTs) into the three upper tier local government structures.
With the LAN now ceasing to exist there is a potential gap in. Over 20
organisations including Lancashire Constabulary, Lancashire County Council,
the Unitary Authorities in Blackpool and Blackburn with Darwen, 12 district
authorities, the newly established Clinical Commissioning Groups Lancashire
health and wellbeing Partnerships (Lancashire only), Community Safety
Partnerships, Childrens' trusts, Safeguarding Boards, local Community Alcohol
Networks (CAN's), licensing, probation, voluntary sector and other alcohol harm
reduction partnerships (including DAATs) make up a virtual network addressing
alcohol related harm. The strategic action plan below is an attempt to introduce a
high level strategic lead to influence these organisations' priorities, allowing them
to concentrate on the areas that are most needed in their localities and by their
audiences. This gives the potential for sharing good practice, developing work
that would be better delivered on a sub-regional level and co-ordinating work to
prevent duplication. It also ensures that there is a focus on alcohol related issues
and associated harm across all age groups and across the pan Lancashire
footprint and enhance and increase the effectiveness of prevention and public
health initiatives.
This can be done by addressing the evidence based 7 High Impact Changes as
key priority areas. These high impact changes are used across the NHS and
local government to highlight practical measures that can be implemented at a
3
local level and have been calculated to have the greatest impact on tackling
alcohol related harm when used in conjunction with each other.
The areas of activity are:
1.
2.
3.
4.
5.
6.
7.
Working in Partnership
Developing activities to control the impact of alcohol misuse in the community
Influence change through advocacy
Improve the effectiveness and capacity of specialist treatment
Appoint an alcohol health worker
IBA – Provide more help to encourage people to drink less
Amplify national social marketing priorities
There is also a need to ensure that we work towards incorporating the NICE
Guidance and recommendations into an action plan and other locality action
plans.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Price
Availability
Marketing
Licensing
Resources for screening and brief interventions
Supporting children and young people aged 10 to 15 years
Screening young people aged 16 and 17 years
Extended brief interventions with young people aged 16 and 17 years
Supporting Students at our local Universities
Screening Adults
Brief advice for adults
Extended brief interventions for adults
Referral
Our aim is to - work together to minimise the health harms, violence and antisocial behaviour associated with alcohol, while ensuring that people are able to
enjoy alcohol safely and responsibly. (Adapted from Safe, Sensible and Social
2007)
And our vision is to - To create healthier, resilient and safer communities for
Lancashire citizens free from alcohol harm
4
This vision echo’s the WHO 2010 vision “Improved health and social outcomes
for individuals, families and communities, with considerably reduced morbidity
and mortality due to harmful use of alcohol and their ensuing social
consequences”
5
Strategy Summary
6
ACTION PLAN SUMMARY 2014/15
Agencies and Partnerships may consider sign up to the actions that are pertinent and prioritised for
the community which they serve.
ACC Bates has agreed to create a ‘virtual’ governance approach to progress on actions
relevant to each partner and to call people together if needed only
Provide a safe, enjoyable,
sustainable environment for visitors
and residents to improve the local
economy
Reduce alcohol related and anti-social behaviour
and crime
Reduce alcohol related ill-health
What
Increase hospital support/alcohol
liaison nurses?
Make treatment available in more
locations
Provide a wider range of
treatment pathways
Expand night safe haven type
facilities
Raise awareness of dual
diagnosis and FASD
Lancashire Community Safety
Strategy Group
Carry out multi-agency
enforcement activity
Consider the use of EMRO's and
evaluate, late night levies,
saturation policies
Develop the use of education as
an intervention or alternative to
prosecution for alcohol related
offenders where appropriate
Provide treatment and advice for
offenders and ensure all partners
are aware of and use all available
services and pathways
Develop appropriate alcohol
domestic abuse services
Support national, develop local
marketing campaigns
Effectively police our night time
economy areas and public
spaces
Implement an alcohol settings
approach
Develop alcohol champions
Support and enhance community
alcohol partnerships/networks
Support the introduction of MUP
and multi-by deals ban
Lead
Organisation
CCG's
Public
health/CCG's
Public
health/CCG's
Community Safety
Partnerships
(CSP's)
Public health
Commissioners
Local Authorities
(LA's)/CSP's
Responsible
authorities/CSP's
Local
Authorities/CSP's
When
May - Dec
2014
May – Dec
2015
May – Dec
2015
Dec 2014
Sep 2014
Mar 2014
Mar 2015
Mar 2015
Police
Jun 2015
Public health
Commissioners
Apr 2015
DA teams and LA
Commissioners
All
Apr 2015
Police
Mar 2015
HR/Public health
teams
All
Public health
Commissioners
All
Mar 2015
Dec 2014
Mar 2015
Mar 2015
Mar 2015
7
Provide a safer alcohol-free
environment for children and empower
young people to make informed
decisions in relation to alcohol
Section 1
Improve twilight economy
Local Authorities
Mar 2015
Recognise and maximise industry
obligation to play a key role in
promoting responsible retailing
and a safe drinking culture
Continue young people's
treatment service
Build support services around
hidden harm
All
Dec 2015
Public health
Commissioners
Children and
young people
services
LA's/Childrens'
Trusts
Public health with
Commissioners
Local Authorities
Dec 2014
All
Dec 2015
Develop community engagement
activity
Enhance awareness of MUP
amongst young people
Implement alcohol marketing
code of practice
Promote alternative activities to
drinking alcohol
Dec 2014
Mar 2015
Jul 2015
Dec 2015
Purpose of the strategic framework
The purpose of this framework is to provide a clear, overarching context and direction for a coordinated approach to tackling alcohol-related harm across Greater Lancashire. The Framework will
support the different activities undertaken in Lancashire at county, district and organisational levels,
both within partnerships and by individual organisations.
The Public Health departments aims to direct and strengthen the positive work being carried out
across Lancashire, providing co-ordination, advice and guidance to localities within a framework of
best practice evidence to assist in addressing alcohol-related harm at both individual and population
levels.
Section 2
Alcohol-Related Harm – Context
There is a strong case for focusing on alcohol-related harm. Nationally, the estimated cost of alcohol
misuse is estimated to be around £20 billion a year. These costs are made up of alcohol related health
disorders and disease, crime and anti-social behaviour, loss of productivity in the workplace, and
problems for those who misuse alcohol and their families, including domestic violence. For the NHS
alone, the estimated financial burden of alcohol harm is £2.7 billion per year.1 The estimated cost for
alcohol related crime and anti-social behaviour each year is £7.3 billion, and £6.4 billion in lost
productivity of workers in their work place which may result in shorter working lives. The human and
emotional impact of victims of alcohol related crime costs around £4.7 billion per year for example,
there are between 780,000 and 1.3 million children affected by parental alcohol problems. 2
In Lancashire the total cost burden of alcohol in 2010/11 was £458 per person, 18% above the national
average of £387. A breakdown of costs for Lancashire 14 can be found in the Lancashire alcohol JSNA
( www.lancashire.gov.uk/jsna/lifestyle/Alcohol/The Cost of Alcohol to the North West economy )
1
2
The cost of alcohol harm to the NHS in England. An update to the Cabinet Office (2003) July 2008, Health Improvement Analytic al Team.
Statistics on alcohol. Rachael Harker House of Commons Library 30 December 2010
8
The impact of alcohol misuse is so widespread in local communities that large-scale action to reduce
alcohol-related harm is likely to also have a positive effect on other priorities and targets for instance:
improving liver health
reducing the incidence of CVD, liver disease, hypertension and some cancers
reducing teenage pregnancy and STI incidence for
reducing the incidence of domestic violence
reducing crime
reducing health inequalities.
Health inequalities associated with alcohol are clearly evident, alcohol-related death rates and
deprivation in England and Wales have shown a strong association, with alcohol-related death rates
more than five times higher in males and more than three times higher in females for those living in the
most deprived areas compared to those in the least deprived areas. 3
Since the second National strategy "Safe Sensible Social: The Next Steps in the Alcohol Harm
Reduction Strategy" 2007 and "Safe Sensible Social: Further Consultation" 2008 there has been an
increased focus nationally on the need to enhance the knowledge and capacity of local partnerships to
tackle alcohol-related harm. As part of the Healthy Lives, Healthy People NHS reforms a proposed
framework for public health outcomes and other relevant frameworks will provide the vehicle for
developing outcome indicators and performance indicators for the future. This is likely to still include
the rate of hospital admissions per 100,000 for alcohol-related conditions, and the mortality rate from
chronic liver diseases in persons under 75 years.
Until then, some of the existing measures will still be used as an indicator of performance. In the
longer term, this Strategic Partnership and the Health and Wellbeing Board's will determine the most
effective way to performance manage alcohol improvement, in line with new guidance and policies.
National Drivers
There are a number of National Drivers for Alcohol which include;
Alcohol: Can the NHS afford it? (RCP 2001)
Alcohol Needs Assessment Research Project (ANARP) The 2004 national alcohol needs
assessment for England
Choosing Health – the Public Health White Paper (DH 2004)
The Alcohol Harm Reduction Strategy for England (DH 2004)
Safe, Sensible, Social: The next steps in the National Alcohol Strategy (DH 2007)
Reducing Alcohol Related Harm – Health Services in England for Alcohol misuse (NAO 2008)
Cutting Crime – A New Partnership 2008-11
The Licensing Act 2003
Police Reform and Social Responsibility Bill - March 2011
Drug Strategy 2010
Signs for Improvement: Commissioning interventions to reduce alcohol-related harm (DH
2009)
Healthy lives, healthy people: strategy for public health in England (DH 2010)
3
Health Statistics Quarterly 33 Spring 2007 Office of National Statistics
9
Models of care for alcohol misusers (MoCAM) (DH 2006)
The National Institute of Health and Clinical Excellence (NICE) has produced a set of harmful
alcohol use guidelines.
o
o
o
o
Alcohol use disorders: diagnosis, assessment and management of harmful drinking and
alcohol dependence
Alcohol-use disorders: preventing the development of hazardous and harmful drinking
Alcohol-Use Disorders Clinical Management Physical Conditions
Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical
complications
A number of the above drivers are either being superseded or currently undergoing change to reflect
the on-going changes within the public sector. The strategy will however, put in place an outcomescentred performance management framework that will assist us to evaluate progress against objectives
and identify current gaps in alcohol improvement interventions.
Section 3
Why alcohol-related harm reduction is important in Lancashire
Whilst the picture is a varied one across the County, Lancashire with the rest of the UK shares a deep
and increasing concern about the levels and patterns of drinking and the subsequent harms caused. At
the launch of Drinkwise North West, Dr Ruth Hussey commented that;
"Alcohol is having a significant impact on life across the North West. It is costing people their jobs, their
health and their lives. Enough is enough. It's time to act - to work together to create a healthier, safer
North West, free from alcohol harm."
Dr Ruth Hussey, Regional Director of Public Health, North West
The evidence base for alcohol harm in Lancashire
A range of evidence and information can be found within:
The Lancashire Joint Strategic Needs Assessment (JSNA)
Local Alcohol Profiles produced by the Public health England,
The findings of the Big Drink Debate 2008.
Trading standards and young people survey 2009
British Crime Surveys
Strategic Assessment of Crime and Disorder 2012 (refresh 2013)
The link between alcohol and crime is well established. According to the 2009/10 British Crime Survey,
victims believed the offender(s) to be under the influence of alcohol in 50% of all violent incidents.
Alcohol also increases the likelihood of becoming a victim of crime.
Lancashire County Council have made a commitment to help adults who are misusing alcohol to make
positive life choices and to safeguard children in homes where alcohol misuse impacts on the care they
received. From the health perspective, the Joint Strategic Needs Assessment identified liver disease as
10
one of ten goals for health equity in Lancashire4. Alcohol abuse and alcohol related violence has been
identified as a top five priority or cross-cutting issue by all 14 Community Safety Partnerships.5
The Big Drink Debate was an anonymous online survey which ran from May to August 2008. It was
the largest survey of its type undertaken in the North West with 6,782 people responding from across
Lancashire. In terms of alcohol consumption more than a quarter (26%) of Lancashire respondents
stated that they drank more that the recognised sensible levels the previous week (21 units for males
and 14 units for females). 17% of Lancashire respondents drank hazardous levels (high risk) of alcohol
in the previous week and 6.2% respondents stated that they drank harmful levels (increasing risk) of
alcohol in the previous week, which is consistent with the North West. There was concern about
alcohol use in the community with the biggest concerns about children drinking in the street and parks
(76.7%) and the drunken behaviour of others (73%). More Lancashire respondents avoid town centres
at night because of the drunken behaviour of others (53%) than was average for the North West (47%).
They also perceived that there is an increase of alcohol related crime in the county compared to the
rest of the North West.
The Lancashire Safeguarding Children Board in 2010 noted that the most prevalent issues in
Lancashire Serious Case Reviews are alcohol abuse and domestic abuse, along with mental health. In
most of the Serious Case Reviews, there was more than one issue present, and alcohol abuse,
domestic abuse and mental illness were often found together. 6
Children and Young People
The new 2011-2013 Lancashire Children and Young People’s Plan identifies one of its priorities as
‘Resilience to risk taking behaviours’ which includes smoking, substance misuse (alcohol and drugs)
and sexual health. There are 63,000 children of secondary age living in Lancashire. If we look at this in
a microcosm it means that if Lancashire where made up of 100 secondary children then 80 would drink
alcohol, 71 of which would binge drink and 40 of which would drink alcohol at least once a week. 7
Alcohol and health in Lancashire
The North West had amongst the highest alcohol-related death rates for both males and females in
England for the decade 2000–09. The region currently has the second highest rate of alcohol related
hospital admissions in England, and it continues to rise faster than in other regions. When comparing
Lancashire with the North West, Lancashire is significantly better than the regional average for hospital
stays for alcohol related harm, however when compared to the England average Lancashire is
significantly worse. (LAPE Profiles)
In relation to binge drinking ( adults) Lancashire is not significantly different from the regional average
but again is significantly worse than the England average. However there are wide variations between
4
Health Inequalities across the Lancashire sub-region. Part of the Lancashire Joint Strategic Needs
Assessment (JSNA) Health & wellbeing of children, adults and older people
5
Lancashire Community Safety Partnership Strategic Assessment 2010/2011
Lancashire Safeguarding Children Board Newsletter Volume 1, Issue 1 JUNE 2010 : SERIOUS CASE REVIEWS
7
Lancashire Children and Young People's Plan consultation report 2011 Children’s Trusts in Lancashire
6
11
and within individual districts 8. The most recent ‘Local Alcohol Profiles for England’9 show that
Lancashire is significantly worse on a number of indicators of alcohol harm than the England average.
All local authorities in Lancashire are worse than the England average death rates for chronic
liver disease. Burnley being significantly worse for both the male and female indicators with
Preston and Hyndburn being significantly worse for the male indicator.
3 local authorities in Lancashire are worse than the England average alcohol specific mortality
rates for males (Burnley, Preston and Hyndburn) with Burnley being significantly worse for
female mortality rates
9 local authorities in Lancashire are significantly worse than England average alcohol-related
harm hospital admissions (NI39) however, Wyre, Fylde and Ribble Valley are significantly better
than England average alcohol-related harm hospital admissions
7 local authorities in Lancashire are significantly worse than England average admission rates
for alcohol problems in under 18’s
All authorities in Lancashire are worse than England average for synthetic estimates of binge
drinking, with 4 authorities being significantly worse (Chorley, Ribble Valley, Rossendale, and
South Ribble
Minimum Unit Pricing (MUP)
When the Government published its Alcohol Strategy in March 2012, minimum unit pricing was central
to the objective of reducing alcohol-related disorder and health harms. This policy announcement was
welcomed by charities and frontline professionals, including police and doctors, who see the
devastating effects of alcohol, day in, day out. However, this was one element of the draft strategy
which was dropped in the Queen's Speech, replaced instead by a ban below cost sales of alcohol.
Minimum unit pricing is the only pricing policy tool which is evidence based and proven to be effective
at a population level. Studies from Canada and the University of Sheffield verify that minimum unit
pricing:
Reduces health harms, crime and disorder and improve economic outputs
Does not unfairly target the poorest in society. A moderate drinker would only pay 28p/week more for
alcohol with a minimum unit price of 50p – and drinks bought in local pubs would not be affected as
average prices are well above 50p per unit.
A 10 per cent increase in the average minimum price of all alcoholic beverages was associated with
an 8.95% decrease in acute alcohol-attributable admissions and a 9.22% reduction in chronic
alcohol-attributable admissions two years later.
Additional plans to introduce alternative measures, such as voluntary local partnerships with retailers, are
not supported by evidence showing that they will be effective in tackling the unacceptable alcohol harm
we face.
Lancashire County Council has recently changed its position in relation to MUP, and supports its
introduction as do Blackpool and Blackburn with Darwen Councils.
Appendix 1 provides further facts on MUP.
Summary of key issues for Lancashire
8
9
Health Profile 2010. North West. Department of Health www.healthprofiles.info
LAPE Local Alcohol Profiles For England downloaded 9/2/11 www.lape.org.uk
12
Alcohol-related harm makes an increasing contribution to reduced life expectancy across much
of Lancashire;
Hospital Admissions for alcohol related harm continue to increase
NW amongst the highest alcohol related deaths for the decade 2000-09
Silent majority - those who in their own homes, are quietly opening a bottle of wine or having a
few cans each evening and over the week unknowingly drinking well above the recommended
limits storing up problems for the future
Ease of access to alcohol
Some alcohol is being sold at too low a unit price
Number of crimes with an alcohol related qualifier
Accidental dwelling fires as a result of cooking whilst under the influence of alcohol
Impact of parental alcohol misuse on children is significant
Section 4
Addressing alcohol related harm in Lancashire
Context
Lancashire, incorporates the 12 districts of Lancashire County Council and the two unitary authorities
of Blackburn with Darwen and Blackpool. The area is very diverse containing some of the most and
least deprived areas in England.
There is a multi-layered system of delivery to address alcohol related harm in Lancashire, which is
currently undergoing a number of changes, due to the public sector reorganisation.
Opportunities within the new system
Opportunities to address alcohol related harm more effectively present themselves in the new
landscape which came into effect on 1 st April 2013, with Public Health making the journey from the NHS
to Local authority.
The approach will be local determination of work focused on what works within a national outcomes
framework. Individual responsibility and community lead approaches determined by what is important to
and within local communities will also be key.
These are the opportunities for a much more integrated approach:
Across tiers of local government
Health and Wellbeing Boards ) will identify priorities for their area to include alcohol harm
reduction
The life course approach contained within government policies on health outline a holistic
approach to tackling alcohol related harm; Lancashire public health service will co-ordinate
health improvement services
Work via the Health and Wellbeing Boards which have a statutory function joining up all the
partners efforts and for producing a high level Health & Well Being Strategy within which alcohol
harm reduction is prioritised
CCG's to take a more holistic approach and a responsibility for prevention
Joining up agendas: links to sexual health, domestic violence, illicit tobacco, substance misuse,
work via new Public Health Service
13
Population level approaches are important because they can help reduce the overall level of alcohol
consumed and therefore lower the population’s risk of alcohol related harm. However, it is also
important that interventions are targeted at an individual level making them aware of risks/ harm of
alcohol at an early stage as they are more like to change their behaviour if it is tackled early.
What more needs to be done?
We need a more scaled up and systematic approach to reducing alcohol related harm in Lancashire.
This includes continuing to work on the high impact changes as they are evidence based interventions.
There needs to be more work on modelling interventions and developing programmes on alcohol liaison
nurses, detoxification and diversion from A&E, which aim to increase efficiency and reduce demand for
health services and therefore costs to the NHS through the QIPP programme (Quality, Innovation,
Productivity and Prevention)
Better community engagement is required to allow the general public and elected members to
understand the issues, particularly around Minimum Unit Pricing, much more clearly
14
Section 5
Action Plan
The focus of the action plan which is provided as a separate document is to bring together relevant
organisations and operate a multi-agency approach to reduce the harm caused by alcohol to
individuals, families and communities. By taking a collaborative approach we can all actively promote
sensible drinking, lessen the harms, and make Lancashire a safer and healthier place to live.
The Action Plan, a summary above contains a range of activities, projects and tasks and is designed to
address the national evidence based High Impact Changes (HIC) and incorporate the NICE guidance
to ensure that activity across the County focuses on the achievement of these aims, coordinating action
to maximise the impact on alcohol-related harm.
The collaborative approach will need to be taken at both Lancashire wide and local partnership levels.
Local partnerships should be able to tailor their approaches to meet the particular needs and priorities
of their communities in line with resources available.
15
Appendices
Appendix 1
Minimum Unit Price and Alcohol Factsheet
Minimum Unit Price Evidence:
Research into the effects of minimum pricing in Canada found that a 10 per cent increase in the average
minimum price of all alcoholic beverages was associated with an 8.95% decrease in acute alcoholattributable admissions and a 9.22% reduction in chronic alcohol-attributable admissions two years
later. A recent paper from the same team demonstrated that a 10% increase in minimum price results in a
fall in alcohol related deaths of over 30%.
University of Sheffield researchers (Sheffield Alcohol Policy Model v.2.5) found a minimum unit price of 50p
in England would reduce crimes by 50,700, and after 10 years, reduce deaths by over 960 and hospital
admissions by 35,100 each year.
The Alcohol Burden:
o
In 2012 alcohol was 61% more affordable than in 1980 (Health and Social Care Information Centre,
2013)
o
Alcohol-related crimes in the North West for 2011/12 stand at 46,700 (Local Alcohol Profiles for
England, 2013)
o
Alcohol related alcohol admissions in England are 1.22million (Health and Social Care Information
Centre, 2013)
o
Alcohol related admissions in the North West were 200,000 in 2011/12 (Health and Social Care
Information Centre, 2013)
o
Alcohol costs the North West over £3 billion. £644 million of these costs are to the NHS alone (Cost
of Alcohol to the North West, 2012)
o
These alcohol costs average £439 for each man, woman and child in the North West – the national
average is only £387/head (The Cost of Alcohol to the North West Economy, 2012)
o
Alcoholic liver disease admissions in the North West have risen by 85% between 2002 and 2012
(Balance, the North East Alcohol Office, 2013)
o
Alcohol related alcohol admissions in England are 1.22million (Health and Social Care Information
Centre, 2013)
o
Alcohol related admissions in the North West were 200,000 in 2011/12 (Health and Social Care
Information Centre, 2013)
o
Alcohol related hospital admissions for the three former Lancashire PCT's areas were 32,000
(2011/12) (North: 8,100; East: 11,500; Central: 12,400) (Health and Social Care Information Centre,
2013)
o
In 2012 alcohol was 61% more affordable than in 1980 (Health and Social Care Information Centre,
2013)
o
Alcohol costs the North West over £3billion - £644million to the NHS (Cost of Alcohol to the North
West 2012)
16
o
Alcohol costs to Lancashire (county level, inc BwD and Blackpool) have been calculated at
£663,610,000 (NHS: £141,920,000; Crime and Licensing: £207,140,000; Workforce and economy:
£272,330,000; Social Services: £42,220,000) (The Cost of Alcohol to the North West Economy,
2012)
o
Alcoholic liver disease admissions in the North West have risen by 85% between 2002 and 2012
(Balance North East, 2013)
17